STACY RELLER (NPI# 1659820264) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659820264 |
| Entity Type | Individual |
| Full Name | STACY RELLER |
| Credential | CPNP-AC |
| Practice Address |
2530 Chicago Ave Ste 400 Minneapolis MN 55404 |
| Mailing Address |
2530 Chicago Ave Ste 400 Minneapolis MN 55404-4387 |
| Practice Telephone | 6128133300 |
| Practice Fax Number | 6128133349 |
| Mailing Telephone | 6128133300 |
| Mailing Fax Number | 6128133349 |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2019-04-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0222X |
Nurse Practitioner Specialization: Pediatrics, Critical Care |
CNP 4769 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2525 Chicago Ave S, Minneapolis, MN 554044518 | 6128136100 |
| Street Address |
2530 CHICAGO AVE STE 400 |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639170418 | Kenneth K Maslonka | Pediatrics | 2530 Chicago Ave Ste 400, Minneapolis, MN 55404-4387 | 2005-08-03 |
| 1659799351 | Brian Jeffrey Carroll | Pediatrics | 2530 Chicago Ave Ste 400, Minneapolis, MN 55404-4387 | 2014-03-31 |
| 1184062663 | Nital Patel | Pediatrics | 2530 Chicago Ave Ste 400, Minneapolis, MN 55404-4387 | 2013-06-06 |
| 1144580424 | Ashley Elizabeth Wilson | Pediatrics | 2530 Chicago Ave Ste 400, Minneapolis, MN 55404 | 2012-05-21 |
| 1326306309 | Nandini Kataria | Pediatrics | 2530 Chicago Ave Ste 400, Minneapolis, MN 55404 | 2012-04-27 |
| 1447525514 | Erin Flynn | Pediatrics | 2530 Chicago Ave Ste 400, Minneapolis, MN 55404 | 2012-03-21 |
| 1407148356 | Alicia M Teagarden | Pediatrics | 2530 Chicago Ave Ste 400, Minneapolis, MN 55404 | 2011-05-11 |
| 1215230354 | Kendall Biallas Baumgartner | Nurse Practitioner | 2530 Chicago Ave Ste 400, Minneapolis, MN 55404-4387 | 2010-12-13 |
| 1225340565 | Katherine Elizabeth Kruse | Pediatrics | 2530 Chicago Ave Ste 400, Minneapolis, MN 55404-4387 | 2010-07-01 |
| 1609197102 | Zahraa Al-lawati | Pediatrics | 2530 Chicago Ave Ste 400, Minneapolis, MN 55404-4387 | 2010-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568062461 | Andrew Moe | Counselor | 2118 Blaisdell Ave S., Minneapolis, MN 55404 | 2020-10-29 |
| 1194368191 | Luz Angelica Fehn Salinas | Psychologist | 1315 E24th St, Minneapolis, MN 55404 | 2019-10-22 |
| 1760969125 | Bethany Karen Kenny | Registered Nurse | 910 E 26th St Ste 200, Minneapolis, MN 55404 | 2018-07-27 |
| 1225535701 | Karissa Dougherty | Nurse Practitioner | 2200 E Franklin Ave # 199, Minneapolis, MN 55404 | 2018-04-10 |
| 1891299491 | Guidance Home Health Care LLC | Home Health | 2529 Nicollet Avenue 202b, Minneapolis, MN 55404 | 2018-03-20 |
| 1770085490 | Bright Future Counseling Service, LLC | Counselor | 912 E. 24th St., Suite B215, Minneapolis, MN 55404 | 2018-03-08 |
| 1346754298 | Juba Pharmacy Inc | Pharmacy | 1926 Chicago Ave S, Minneapolis, MN 55404 | 2017-11-29 |
| 1629597323 | Kira Larson Fieldstrom | Social Worker | 2400 Blaisdell Ave., Minneapolis, MN 55404 | 2017-09-13 |
| 1770008930 | Nicole Lynn Sparks | Social Worker | 2445 Park Avenue, Minneapolis, MN 55404 | 2017-08-09 |
| 1639612765 | Cosmo Home Healthcare Services, L.L.C. | Home Health | 2219 Oakland Ave S, Suite 104, Minneapolis, MN 55404 | 2016-11-21 |
| Find all providers in zip 55404 | ||||
| Taxonomy Code | 363LP0222X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics, Critical Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467016477 | Stephanie Karides | Nurse Practitioner | 2525 Chicago Ave, Minneapolis, MN 55404 | 2019-04-24 |
| 1780190736 | Christine N Boline | Nurse Practitioner | 2525 Chicago Ave, Minneapolis, MN 55404-4518 | 2017-12-28 |
| 1609394295 | Andrea Erdmann | Nurse Practitioner | 2525 Chicago Ave, Minneapolis, MN 55404-4518 | 2017-09-02 |
| 1013382696 | Brittany Lynn Jackson | Nurse Practitioner | 2525 Chicago Ave, Minneapolis, MN 55404 | 2015-12-07 |
| 1184053233 | Kristin Greathouse | Nurse Practitioner | 2450 Riverside Ave, Minneapolis, MN 55454-1450 | 2013-11-08 |
| 1003150194 | Mary Susan Clipp | Nurse Practitioner | 2450 Riverside Ave, Minneapolis, MN 55454-1450 | 2012-11-15 |
| 1376887448 | Gretchen Anne Mcguire | Nurse Practitioner | 2530 Chicago Avenue South, Minneapolis, MN 55404-4289 | 2012-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780092239 | Jennifer Elizabeth Snider | Nurse Practitioner | 81 Alden Cir Ne, Fridley, MN 55432-3024 | 2014-07-29 |
| 1841742533 | Susanna Rose Tran | Nurse Practitioner | 200 University Ave E, Saint Paul, MN 55101-2507 | 2016-10-27 |
| 1992772107 | Rachel Ellen Ridenour Herman | Nurse Practitioner | 5975 Carmen Ave, Inver Grove Heights, MN 55076-4416 | 2006-03-07 |
| 1982680682 | Christine Roberta Poe | Nurse Practitioner | 7675 Madison St Ne, Fridley, MN 55432-2753 | 2005-12-15 |
| City | MINNEAPOLIS |
| Zip Code | 55404 |
Please comment or provide details below to improve the information on STACY RELLER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.